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Thymus (anterior mediastinum; thoracic tumours)

Thymoma and thymic carcinoma

How surgery, radiotherapy, chemotherapy, targeted drugs and immunotherapy have been studied in thymoma and thymic carcinoma.

Thymus cancer (no split by thymoma and thymic carcinoma) · 5-year relative survival · United States (American Cancer Society)

75%

Diagnosed 2015-2021, all SEER stages combined. Read these with the caveats under “Then and now”.Source

22 milestones, by decade

  • Thymic tumours are rare, and the published incidence depends on the source and the definition. The American Cancer Society gives about 1.7 cases per million people a year in the United States and approximately 600 new cases a year, and says the exact number diagnosed is not known. A registry analysis of SEER 22 registries in the United States for diagnoses in 2000 to 2019, directly age-standardised to the 2000 US standard population, reported 2.2 cases per million a year for thymoma and 0.48 per million for thymic carcinoma. The American Cancer Society page does not say which data or years its figure comes from, so the two sets of figures are not compared or combined here.
  • A randomised trial in thymic carcinoma closed early because of slow accrual. S1701, a randomised phase 2 trial, had a target sample size of 66 people with unresectable, locally advanced, recurrent or metastatic thymic carcinoma, to receive carboplatin-paclitaxel with or without ramucirumab. Between 2018 and 2022 only 21 enrolled (8 and 13 in the two arms), and the data and safety monitoring board ended the trial early. The authors conclude that accrual to this population is challenging and call for larger multicentre collaborations.
  • In a single-centre, single-arm phase 2 study of pembrolizumab in 40 evaluable people with recurrent thymic carcinoma who had progressed after at least one line of chemotherapy, 9 had a response (22.5%; 95% CI 10.8 to 38.5). Six people (15%) developed severe autoimmune toxicity, including two (5%) with myocarditis, and the authors state that careful monitoring is essential.

Evidence current to October 2026 · Checked against primary sources to the extent possible

A guided tour of 12 milestones. You can pause or step through it yourself.

Filter milestonesshowing all 22
Treatment type
Setting

The age of rays

  1. 1939 · Origin · SurgeryBlalock 1939: mediastinal mass removed in a patient with myastheniaIn 1939 clinicians at Vanderbilt University reported removing a mass from the thymus region of a young woman with myasthenia gravis, a disease of muscle weakness. She was operated on in 1936 and had only one mild, brief relapse over the next three years. The authors stressed that one case could not prove the operation was the cause.Case report (Blalock, Mason, Morgan and Riven, Ann Surg 1939): woman aged 19 when referred in 1934, myasthenia gravis since age 16, anterior mediastinal shadow, earlier roentgen treatment. Tumour about 6 x 5 x 3 cm, cystic and encapsulated, removed on 26 May 1936; no thymic tissue identified microscopically, read by the pathologist as a probable necrotic thymic tumour. About 3 years later: one mild recurrence with a respiratory infection. Authors: no conclusive proof that removal caused the improvement.

Molecular origins

  1. 1981 · Understanding · UnderstandingMasaoka's clinical stages for thymoma, from a 96-patient seriesIn 1981 a follow-up report on people with thymoma described stages I to IV, defined by how far the tumour had invaded the capsule, nearby tissue and other sites. Five-year survival was lower in higher stages, and lower after non-radical treatment than after total resection. A three-group staging scheme had been applied to a smaller series in 1978.Follow-up of 96 thymomas (Masaoka, Cancer 1981). Stages (abstract wording): I macroscopically encapsulated, no microscopic capsular invasion; II "macroscopic invasion into surrounding fatty tissue of mediastinal pleura, or microscopic invasion into capsule" (as printed); III macroscopic invasion of a neighbouring organ; IVa pleural or pericardial dissemination; IVb lymphogenous or haematogenous metastasis. Five-year survival 92.6% (I), 85.7% (II), 69.6% (III), 50% (IV); 88.9% after total resection, 44.4% in the non-radically treated group.
  2. 1991 · Treatment · ChemotherapyCisplatin-based chemotherapy for advanced thymoma, 1991-2001Small single-arm studies from 1991 to 2001 tested cisplatin-based combinations in advanced thymoma and reported tumour responses. In a 1994 US intergroup study, half of 30 assessable people responded. With no comparison groups and different drugs and patients, the studies cannot be ranked against each other.Four single-arm studies, each reported separately; response criteria are not stated in the abstracts. ADOC (Padova, n=37): response 91.8%, median survival 15 months. PAC (intergroup, 30 assessable): response 50% (95% CI 31.3-68.7), median survival 37.7 months. Cisplatin-etoposide (EORTC, n=16): median survival 4.3 years. VIP (intergroup, 28 evaluable): response 32% (95% CI 16-52), median survival 31.6 months.
  3. 1991 · Treatment · ChemotherapyNeoadjuvant chemotherapy before surgery for invasive thymomaA 1991 report described seven people with invasive thymoma who had chemotherapy before surgery and radiation after it. All seven had tumour shrinkage of more than half, and six were alive and free of disease at the report. A later phase 2 study of 22 people used a related plan. Neither compared it with surgery first.Macchiarini (7 patients, stage IIIa invasive thymoma): 3 cycles of cisplatin, epirubicin and etoposide, surgery, then 46 to 60 Gy; all had a partial response; projected 2-year survival 80%. Kim phase II (22 patients, stage III to IVB): induction chemotherapy, resection, radiotherapy, consolidation chemotherapy; major responses 77%, complete resection 76% of 21 explored, 5-year OS 95%, PFS 77%. Single-arm studies; no comparison with up-front surgery.
  4. 1991 · Understanding · UnderstandingThymic carcinoma: a 60-case clinicopathologic study (1991)A 1991 study of sixty people with thymic carcinoma found two clinically different groups: some with a favourable course and long survival, others with a rapidly fatal one. How the tumour looked under the microscope, especially its type and grade, was the most reliable predictor of outcome. No treatment showed a significant link with survival.Suster and Rosai 1991, 60 patients with thymic carcinoma. Overall survival 56.6% at 1 year, 40% at 3 years, 33.3% at 5 years. Of patients with poorly circumscribed or infiltrating tumours 88% died of tumour versus 16.6% with well-circumscribed tumours; 84.6% versus 0% for high-grade versus low-grade histology. Treatment modality showed no significant correlation with survival; histologic type and grade were the most reliable predictors.
  5. 1994 · Understanding · UnderstandingKoga's 1994 modification of the Masaoka stages (79 thymomas)A 1994 pathology study of operated thymomas compared Masaoka's stages with a modified version and argued that the traditional division into invasive and non-invasive thymoma should be reappraised. The Masaoka-Koga stage table reproduced in a 2024 review splits stage II into two parts. A 2011 paper on the system is titled a clarification and definition of terms.Koga 1994: 79 surgically resected thymomas, Masaoka and modified Masaoka stages compared; the modification adjusted for the disproportion in case numbers between stages I and II. The authors proposed reappraising the invasive versus non-invasive division and grading aggressiveness (histology, cytopathology) beside stage. A 2024 review's Masaoka-Koga table splits stage II into IIa (microscopic transcapsular invasion) and IIb (macroscopic invasion into thymic or surrounding fatty tissue, or grossly adherent to but not breaking through mediastinal pleura or pericardium).
  6. 1996 · Understanding · SurgeryComplete resection and stage as prognostic factors in thymomaThree surgical series looked at what predicts survival after an operation for a thymic tumour. In each, people whose tumour could be removed completely, or was at an earlier stage, tended to live longer. These are records of past patients, so they show association, not that surgery caused the difference.Regnard (307 operated patients, 196 with myasthenia gravis): 10- and 15-year survival 67% and 57%; completeness of resection was the sole significant factor on multivariate analysis. Kondo (1,320 patients, Japan): 5-year survival in stage III-IV thymoma 93% after total resection, 64% after subtotal and 36% if inoperable. Ruffini (ESTS database): OS HR 1.74 (95% CI 1.18-2.57) for incomplete resection; stage IV versus I, 4.41 (2.67-7.26).

Targeted therapy

  1. 1999 · Understanding · UnderstandingWHO classification of thymic tumours: types A to B3 and carcinomaPathologists sort thymus tumours by how the cells look: thymoma types A, AB, B1, B2 and B3, and thymic carcinoma. The WHO scheme dates from its 1999 edition and has been revised since. One long series linked the types to survival; a larger database found that, with age, stage and resection accounted for, type related to recurrence but not survival.WHO type A, AB, B1-B3 thymoma nomenclature (second edition 1999; kept in 2004 and 2015; fifth edition 2021) plus thymic carcinoma. Okumura (273 thymomas, 44 years): 20-year survival 100%, 87%, 91%, 59%, 36% for types A to B3; WHO type and Masaoka stage were independent prognostic factors. International Thymic Malignancy Interest Group database (4221 thymomas): in multivariable analysis histology affected recurrence, not survival.
  2. 1999 · Treatment · RadiationPostoperative radiotherapy in stage I thymoma: randomised trialA small randomised trial from Beijing compared surgery alone with surgery followed by radiotherapy in 29 people with stage I thymoma. No tumour came back in either group, and the authors reported no difference in survival. With so few people, the trial cannot show whether radiotherapy can be left out.Randomised, 29 patients with stage I thymoma under 65 (treated 1981-1996): surgery alone (13) versus surgery plus postoperative radiotherapy (16). No recurrence or metastasis in either group. Reported 5- and 10-year survival 92% with surgery alone and 88% with radiotherapy. Three deaths (one myasthenia gravis, two intercurrent illness). No confidence intervals, hazard ratio or P value in the abstract; randomisation method and primary end point not stated.
  3. 2004 · Treatment · Endocrine⚑ needs reviewOctreotide with or without prednisone (ECOG phase 2)In a US cooperative-group study, 42 people with advanced thymoma or thymic carcinoma and a positive octreotide scan received octreotide, with prednisone added in some. The paper reports two complete and ten partial responses (38 people were fully assessable); none of six people without pure thymoma responded. There was no comparison group.ECOG single-arm phase 2: octreotide 0.5 mg subcutaneously three times daily in advanced thymoma or thymic carcinoma with a positive octreotide scan (42 entered, 38 fully assessable); prednisone added at 2 months in patients with neither response nor progression. Two complete (5.3%) and 10 partial responses (25%) as printed, four partial responses with octreotide alone; none of six patients without pure thymoma responded. 1- and 2-year survival 86.6% and 75.7%.
  4. 2010 · Treatment · Chemotherapy⚑ needs reviewInduction chemotherapy and chemoradiotherapy: JCOG9606, KorstTwo small phase 2 studies gave chemotherapy, in one study together with radiotherapy, before surgery to people with locally advanced thymic tumours. Some tumours shrank and some were removed completely, and two people in one study died after surgery. Neither compared this approach with surgery first.JCOG9606 (phase II; 23 entered, 21 eligible; unresectable stage III thymoma): dose-dense cisplatin-based chemotherapy, then resection and/or radiotherapy; partial response 13 of 21 (62%, 95% CI 38-82%), complete resection in 9 (43% of eligible), 5-year PFS 43% (primary end point), 5-year OS 85%. Korst (phase II, 22 patients): cisplatin-etoposide with 45 Gy; R0 resection 77%, grade 3 or 4 toxicity 41%, postoperative death 9%.

Immunotherapy

  1. 2011 · Treatment · ChemotherapyCarboplatin-paclitaxel in thymoma and thymic carcinomaTwo single-arm studies tested carboplatin plus paclitaxel in thymic tumours. In a US study of 46 people, tumours shrank in about two in five with thymoma and about one in five with thymic carcinoma. In a Japanese study of 40 people with thymic carcinoma, just over one in three responded. Neither study had a comparison group.Two single-arm phase 2 studies of carboplatin (AUC 6) plus paclitaxel every 3 weeks. Lemma (46 enrolled, untreated): ORR 42.9% in the thymoma cohort and 21.7% in the thymic carcinoma cohort (90% CIs); median PFS 16.7 and 5.0 months. WJOG4207L (40 enrolled, thymic carcinoma, independent review): ORR 36% (95% CI 21-53); median PFS 7.5 months (95% CI 6.2-12.3). Cohorts and criteria differ; no cross-trial comparison.
  2. 2011 · Treatment · Surgery⚑ needs reviewMinimally invasive versus open thymectomy: registry comparisonsRegistries and hospital series have compared keyhole (minimally invasive) with open surgery for thymoma. They report shorter hospital stays with keyhole surgery, and no significant difference in complete removal or survival in the matched analyses. A European registry found lower odds of incomplete removal with robotic than with thoracoscopic surgery. None is randomised.Observational comparisons of minimally invasive and open thymectomy. ITMIG (2,514 patients): R0 resection 94% minimally invasive versus 86% open; 96% in both groups after propensity matching (266 per group, P = 0.7). National Cancer Data Base (1,223 patients, stage I-III): in the matched analysis 5-year survival did not differ significantly (P = .20); median stay 3 versus 4 days. ESTS: robotic versus video-assisted, odds ratio for R1 resection 0.203 (95% CI 0.13-0.317).
  3. 2014 · Understanding · UnderstandingGTF2I mutation in thymomas and the genomic landscape of thymic tumoursIn 2014 researchers sequencing thymic tumours found one specific change in the GTF2I gene in most type A and AB thymomas, the slower-growing kinds, and rarely in the more aggressive types. A 2018 multi-platform study sorted tumours into four molecular subtypes. Both papers describe the biology; neither tests a treatment.Petrini 2014: GTF2I c.74146970T>A in 119 of 270 thymic epithelial tumours: 82% of type A, 74% of type AB, 3 of 36 thymic carcinomas. Ten-year survival 96% mutant versus 70% wild-type (log-rank P < 0.001); within thymomas 96% versus 88% (P = 0.057); in a model combining stage, WHO type and GTF2I status only stage was independent. Radovich 2018 (TCGA, 117 tumours): four molecular subtypes; GTF2I mutated in 39% (100 pairs analysed).
  4. 2014 · Understanding · UnderstandingIASLC/ITMIG TNM proposals for thymic tumours (eighth edition)Thymic tumours had no official AJCC/UICC stage classification when an international group pooled records from many centres and, in 2014, proposed a TNM system for the eighth edition. It rests on how far the tumour invades nearby structures, not on size, and was adopted for the eighth edition. A later proposal adds a size cut-off within the T1 category.IASLC/ITMIG retrospective database of 10,808 patients from 105 sites. Proposed T1 to T4 by level of invasion (size not useful), N1 anterior and N2 deep, M1a pleural or pericardial nodules and M1b pulmonary parenchymal or distant disease; adopted in the eighth edition. Ninth-edition project (11,347 patients, 9,147 with survival data): T1a up to 5 cm, T1b over 5 cm, lung and phrenic nerve invasion in T2; N and M unchanged.
  5. 2015 · Treatment · Radiation⚑ needs reviewPostoperative radiotherapy: conflicting registry dataMost evidence on radiotherapy after surgery for thymoma comes from records of past patients, and the studies disagree. A Japanese database found no link between radiotherapy and survival in thymoma; an international database found longer survival among people who had radiotherapy. A randomised trial, RADIO-RYTHMIC, is testing the question.Retrospective data conflict. JART (stage II/III, 1,265 patients): PORT not associated with RFS or OS in thymoma (P = .350); in thymic carcinoma RFS HR 0.48 (95% CI 0.30-0.78), OS HR 0.94 (0.51-1.75). ITMIG (1,263 R0 stage II/III thymoma): 5-year OS 95% with PORT versus 90% without (P = 0.002). Meta-analyses of retrospective studies, PORT versus surgery alone: OS HR 0.68 (0.57-0.83) in five studies; 0.73 (0.59-0.91) in 31, with stage 2 HR 0.81 (0.55-1.19).
  6. 2015 · Treatment · TargetedSunitinib after chemotherapy: NCI phase 2 and STYLETwo phase 2 studies tested the targeted drug sunitinib in thymic tumours that had progressed on chemotherapy. Between one in five and one in four people with thymic carcinoma had tumour shrinkage; responses were few in thymoma. Neither study had a comparison group, and side effects were common.Two single-arm phase 2 trials of sunitinib 50 mg daily, 4 weeks on and 2 weeks off. NCI (41 enrolled): partial responses in 6 of 23 assessable thymic carcinoma (26%, 95% CI 10.2-48.4) and 1 of 16 thymoma (6%, 95% CI 0.2-30.2). STYLE (44 enrolled, Simon two-stage): ORR 21.7% in thymic carcinoma (90% CI 9.0-40.4); thymoma cohort closed after stage 1 (ORR 0%). STYLE median PFS 8.8 months (thymic carcinoma) and 7.7 months (thymoma).
  7. 2018 · Treatment · ImmunotherapyPembrolizumab in thymic tumours: activity and autoimmune toxicityTwo small single-arm studies tested the immunotherapy pembrolizumab in thymic tumours that had progressed on chemotherapy. In thymic carcinoma, about one in five people had tumour shrinkage. Serious autoimmune side effects, including heart inflammation, were common, especially in the few people with thymoma. Neither study had a comparison group.Two single-arm phase 2 studies of pembrolizumab 200 mg every 3 weeks after chemotherapy. Georgetown (thymic carcinoma, 40 evaluable): response 22.5% (95% CI 10.8-38.5); severe autoimmune toxicity 15%, myocarditis 5%. Samsung (thymic epithelial tumours, n=33): partial responses in 2 of 7 thymoma and 5 of 26 thymic carcinoma; median PFS 6.1 months in both groups; grade 3 or worse immune-related events in 5 of 7 and 4 of 26. Not comparable across studies.

Precision & engineered

  1. 2020 · Treatment · TargetedREMORA: lenvatinib in thymic carcinoma; Japan indication 2021In a Japanese study of 42 people whose thymic carcinoma had progressed after platinum chemotherapy, the targeted drug lenvatinib shrank tumours in about two in five. High blood pressure was the commonest severe side effect. There was no comparison group. Japan added thymic carcinoma to the lenvatinib label in March 2021.REMORA, single-arm phase 2 at eight Japanese institutions: lenvatinib 24 mg daily after at least one platinum-based regimen for unresectable thymic carcinoma (n=42). Primary endpoint ORR by independent central review (ITT): 38% (90% CI 25.6-52.0; p<0.0001), 16 partial responses; median follow-up 15.5 months. Grade 3 hypertension 64%. Long-term follow-up: median OS 28.3 months (95% CI 17.1-34.0); 36-month OS 35.7%.
  2. 2024 · Treatment · TargetedRamucirumab with carboplatin-paclitaxel: RELEVENT and S1701Adding the antiangiogenic drug ramucirumab to carboplatin and paclitaxel was tested in untreated thymic carcinoma in two small studies. In a single-arm Italian study of 35 people, most had tumour shrinkage. A randomised US study closed after 21 people: response was higher with ramucirumab, but progression-free survival was not statistically different.RELEVENT, single-arm phase 2 (n=35): ORR 80.0% (95% CI 63.1-91.6) by investigator, 57.6% (95% CI 39.2-74.5) at central review of 33; median PFS 18.1 months, median OS 43.8 months. S1701, randomised phase 2, closed early after 21 patients (ramucirumab arm 8, control 13): PFS hazard ratio 0.51 (80% CI 0.24-1.09), p=0.13; median PFS 8 vs 7 months; ORR 88% (7/8) vs 40% (4/10), p=0.04.
  3. 2025 · Treatment · ImmunotherapyMARBLE: atezolizumab with carboplatin-paclitaxel in thymic carcinomaIn a Japanese study of 48 people with advanced or recurrent thymic carcinoma and no earlier drug treatment, adding the immunotherapy atezolizumab to carboplatin and paclitaxel shrank tumours in just over half. Low white blood cell counts were the commonest severe side effect. There was no comparison group.MARBLE, single-arm phase 2 at 15 Japanese hospitals: atezolizumab 1200 mg with carboplatin AUC 6 and paclitaxel 200 mg/m2 every 3 weeks (up to six cycles), then atezolizumab for up to 2 years, in untreated stage III-IVB or recurrent thymic carcinoma (n=48). Primary endpoint ORR by independent central review, per-protocol set: 56% (95% CI 41-71), 27 partial responses; median follow-up 15.3 months. Grade 3 or worse neutropenia 56%; no treatment-related deaths.
  4. 2025 · Treatment · ImmunotherapyPerioperative pembrolizumab with chemotherapy in advanced TETA single-arm phase 2 study gave the immunotherapy pembrolizumab with chemotherapy before and after surgery to 40 people with advanced thymic tumours. Almost half of those who had surgery had a major pathologic response, all in thymic carcinoma. Two people with thymoma died of myocarditis. There was no comparison group.Single-arm phase 2 (NCT03858582), 40 untreated patients with Masaoka-Koga stage III-IV thymic epithelial tumours: 3 cycles of docetaxel, cisplatin and pembrolizumab, surgery, then pembrolizumab for 2 years. Of 28 resected, MPR 46.4% (primary end point) and pCR 17.9%, all in thymic carcinoma, none in thymoma. 1-year DFS 91.0% (95% CI 79.9-100.0); median DFS 49.3 months; median follow-up 27.5 months. Grade 3: 22.5%; grade 4: 12.5%; two thymoma patients died of myocarditis.

Then and now

  • 5-year relative survival · United States (American Cancer Society)

    • 75%

      Diagnosed 2015-2021, all SEER stages combined

    People diagnosed with thymus cancer between 2015 and 2021 in the United States, all SEER stages combined, as given on the American Cancer Society page 'Survival Rates for Thymus Cancer'. The page gives no separate figures for thymoma and thymic carcinoma and states no age range, sex or number of people.

    Secondary source: the American Cancer Society says it relies on the SEER database and cites SEER*Explorer (accessed 13 June 2026), but does not name the SEER registry set. A relative survival rate compares people with this cancer with the general population. By the page's own list, the figures do not account for age, overall health, type of thymus cancer, whether the whole cancer can be removed or how well it responds to treatment, and they apply to stage at first diagnosis only. The page adds that people diagnosed more recently may have a better outlook, because these figures describe people diagnosed and treated at least five years earlier. SEER's Cancer Stat Facts has no page for the thymus, and no earlier-period series for the thymus alone is available from the sources used here, so there is no 'then' value to set beside this one and no change over time is implied.

    Source

  • 5-year relative survival · United States (American Cancer Society)

    • 94%

      Diagnosed 2015-2021, localized stage

    • 79%

      Diagnosed 2015-2021, regional stage

    • 42%

      Diagnosed 2015-2021, distant stage

    Thymus cancer by SEER stage at diagnosis, for people diagnosed between 2015 and 2021 in the United States, as given on the American Cancer Society page 'Survival Rates for Thymus Cancer'. Localized means the cancer is only in the thymus with no sign of spread, regional means it has spread outside the thymus to nearby structures or lymph nodes, and distant means it has spread to distant parts of the body, such as the lining of the heart or the lungs. The page states that SEER does not group cancers by AJCC TNM stage. It gives no separate figures for thymoma and thymic carcinoma and states no age range, sex or number of people.

    Secondary source: the American Cancer Society says it relies on the SEER database and cites SEER*Explorer (accessed 13 June 2026), but does not name the SEER registry set. These are separate figures for three stage groups of the same 2015-2021 group of people, not a change over time, and they are not to be subtracted from one another or from the all-stages figure. They apply to stage at first diagnosis only, and by the page's own list they do not account for age, overall health, type of thymus cancer, whether the whole cancer can be removed or how well it responds to treatment.

    Source

Survival figures are affected by earlier detection (lead time) and overdiagnosis, and by changes in who is diagnosed. For screened cancers, read them alongside mortality.

Evidence chains

A lane follows one defined population and setting, where each new trial tests against what was then standard. Compare only within a lane, and read every comparison as illustrative.

Stage I thymoma: surgery alone versus surgery plus postoperative radiotherapy

People younger than 65 with stage I thymoma (complete capsule, no microscopic capsular invasion) treated between 1981 and 1996 · Adjuvant · endpoint: OS

Results are not comparable across trials.

This lane holds a single randomised trial of 29 patients (13 and 16 per arm), so nothing is compared across trials. The abstract gives 5- and 10-year overall survival from Kaplan-Meier estimates, with no confidence intervals, hazard ratio or test; its authors reported no difference in survival, and no recurrence or metastasis in either group. With so few patients, the trial cannot show whether radiotherapy can be left out. The method of randomisation, the primary end point and the length of follow-up are not stated in the abstract, and treatment dates from 1981 to 1996, so staging, surgical and radiotherapy practice differ from today. Observational data on radiotherapy after resection of stage II or III thymoma concern a different population and are not part of this lane. Compare only the trial's own two arms.

Each pair shows one trial: its control arm and its experimental arm. Yesterday's experimental arm is often today's control. Populations, definitions and follow-up differ.

020406080100OS at 60 months (%)1999zhang-1999-stage-i-port-thymoma
  • experimental arm
  • control arm
  • different endpoint from the lane's
  • step line through experimental values
OS at 60 months, rate, across 1 trial in this lane. zhang-1999-stage-i-port-thymoma (1999): experimental 88 % vs control 92 %.
Data table
TrialYearEndpointControl (%)Experimental (%)
zhang-1999-stage-i-port-thymoma1999OS92 %88 %

Thymic carcinoma, no earlier systemic therapy: carboplatin and paclitaxel as the backbone

Advanced, recurrent or metastatic thymic carcinoma with no earlier systemic therapy for advanced disease · Metastatic · endpoint: PFS

No comparable values to plot for this lane yet.

Today and tomorrow

Standard of care today

Localised
The NCI PDQ summary for health professionals (the page shows an update of 25 October 2024) names surgical resection, with en bloc resection of invasive tumours where possible, as the primary treatment of thymoma and thymic carcinoma. It lists surgery alone for stage I thymoma and surgery with or without postoperative radiotherapy for stage II, and says the role of adjuvant radiotherapy after complete resection of stage II thymoma needs further study. The summary states that it is not a formal guideline. The abstract of the NCCN guideline (Version 2.2025) states that involvement of a multidisciplinary team experienced in treating these tumours is highly recommended. The NCCN guideline and the ESMO guideline (2015 edition) are cited by identifier only, and their recommendation text was not opened.
National Cancer Institute, PDQ Adult Treatment Editorial Board 2024Guideline: Riely GJ, Wood DE, Loo BW Jr, Aisner DL, Akerley W, Bauman JR, et al 2025Guideline: Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S 2015
Adjuvant
Whether postoperative radiotherapy improves survival after complete resection of stage II or III thymoma is the subject of registered randomised trials with no results posted on the registry, and observational analyses disagree. In the Japanese JART database (1,265 people with stage II or III disease, 1,110 with thymoma and 155 with thymic carcinoma), radiotherapy was not associated with relapse-free or overall survival in thymoma (P = .350). In thymic carcinoma it was associated with longer relapse-free survival (hazard ratio 0.48; 95% CI 0.30 to 0.78) but not overall survival (hazard ratio 0.94; 95% CI 0.51 to 1.75). In the ITMIG database (1,263 people with completely resected stage II or III thymoma), 5- and 10-year overall survival was 95% and 86% with radiotherapy and 90% and 79% without it (P = 0.002). A meta-analysis of five observational studies (4,746 people) reported a hazard ratio for overall survival of 0.68 (95% CI 0.57 to 0.83) and no association with disease-free survival (hazard ratio 0.96; 95% CI 0.70 to 1.33), and its authors state that a randomised trial is warranted. The authors of a French consensus paper on radiotherapy technique describe whether to give postoperative radiotherapy as a major remaining issue. Registered randomised trials are listed under trials to watch.
Omasa M, Date H, Sozu T, Sato T, Nagai K, Yokoi K, et al 2015Rimner A, Yao X, Huang J, Antonicelli A, Ahmad U, Korst RJ, et al 2016Tateishi Y, Horita N, Namkoong H, Enomoto T, Takeda A, Kaneko T 2021Basse C, Khalifa J, Thillays F, Le Pechoux C, Maury JM, Bonte PE, et al 2024
Locally advanced
For operable or potentially operable stage III to IV thymoma the PDQ summary lists surgery followed by radiotherapy, or induction chemotherapy followed by surgery and radiotherapy. For inoperable disease it lists chemotherapy, chemotherapy followed by radiotherapy, or chemotherapy followed by surgery (if operable) and radiotherapy. It reports response rates of 79% to 100% to induction chemotherapy and resectability rates of 36% to 69% in published series, and states that the optimal strategy for induction therapy is not defined. For thymic carcinoma it calls the optimal treatment undefined. A randomised phase 2/3 trial of 6 versus 3 cycles of neoadjuvant chemotherapy is registered (NCT07463313, not yet recruiting).
National Cancer Institute, PDQ Adult Treatment Editorial Board 2024ClinicalTrials 2026
Metastatic
For untreated advanced or recurrent thymic carcinoma, the authors of the MARBLE paper (a single-arm phase 2 trial in Japan, 48 people) state that carboplatin plus paclitaxel remains a standard treatment. With atezolizumab added, the objective response rate was 56% (95% CI 41 to 71), with grade 3 or worse neutropenia in 27 of 48 people (56%) and no treatment-related deaths. S1701 randomised ramucirumab with carboplatin-paclitaxel against carboplatin-paclitaxel alone but closed early with 21 people enrolled, and reported a progression-free survival hazard ratio of 0.51 (80% CI 0.24 to 1.09; P = 0.13), which the authors describe as not statistically different. In Japan, the health ministry's Report on the Deliberation Results dated 3 December 2025 records that its Second Committee on New Drugs, meeting on 27 November 2025, concluded that the partial-change application for Tecentriq 1,200 mg (filed 14 May 2025) may be approved, and the PMDA review report of 10 November 2025 for the same application judged efficacy in unresectable thymic carcinoma to be shown and added that indication to the proposed indications. The final approval notice was not read in a regulator document, and an industry news report dated 27 December 2025 describes the approval.
Shukuya T, Asao T, Goto Y, Mimori T, Takayama K, Kaira K, et al 2025Tsao AS, Hsieh MH, Koczywas M, Tu J, Riess J, Tanvetyanon T, et al 2024Ministry of Health, Labour and Welfare (Japan), Report on the Deliberation Results, 3 December 2025, and Pharmaceuticals and Medical Devices Agency Review Report, 10 November 2025: Tecentriq for Intravenous Infusion 1,200 mg (atezolizumab), partial change application for unresectable thymic carcinoma (Japanese original) 2025IPP Bureau 2025
Relapsed / refractory
After platinum-based chemotherapy, the REMORA paper (2020) states that a standard treatment had not been established. In that single-arm phase 2 trial of lenvatinib (42 people with thymic carcinoma) the objective response rate was 38% (90% CI 25.6 to 52.0), and grade 3 hypertension occurred in 27 people (64%). In Japan, the PMDA review report of 1 February 2021 concluded that lenvatinib may be approved for unresectable thymic carcinoma, the health ministry's Report on the Deliberation Results of 3 March 2021 records the committee's conclusion that the application may be approved, and the PMDA re-examination report of 13 April 2026 lists the addition of this indication on 23 March 2021. The National Cancer Center and Eisai with MSD each announced the approval on 23 March 2021. For recurrent thymoma and thymic carcinoma the PDQ summary lists chemotherapy, biological therapies (octreotide with or without prednisone, sunitinib, everolimus, lenvatinib), and surgery or radiotherapy in selected cases. It says no randomised trials of chemotherapy in recurrent disease have been conducted, and that immune checkpoint inhibitor therapy is under clinical evaluation and should be used in the context of a clinical trial.
Sato J, Satouchi M, Itoh S, Okuma Y, Niho S, Mizugaki H, et al 2020Pharmaceuticals and Medical Devices Agency (Japan) 2021Pharmaceuticals and Medical Devices Agency (Japan) 2026National Cancer Center (Japan) 2021Eisai Co 2021National Cancer Institute, PDQ Adult Treatment Editorial Board 2024
Any setting
No FDA or EMA indication for thymoma or thymic carcinoma appears in the documents read for this page. The US prescribing information on DailyMed for lenvatinib (Lenvima, label effective 14 October 2026) lists differentiated thyroid cancer, renal cell carcinoma, hepatocellular carcinoma and endometrial carcinoma, and the atezolizumab (Tecentriq, label effective 13 October 2026) label does not mention thymic tumours. The Drugs@FDA overview pages for Lenvima (NDA 206947) and Tecentriq (BLA 761034) were also opened; the most recent supplement listed as an efficacy new indication is dated 24 September 2026 for Lenvima and 8 October 2026 for Tecentriq, and neither page mentions the thymus. The EMA product pages for Lenvima (last updated 26 March 2026) and Tecentriq (last updated 21 July 2026) do not mention thymoma or thymic carcinoma. Searches of the openFDA drug label indications field for thymoma, thymic, thymic carcinoma, thymic epithelial and thymic tumor found only a 2010 label whose indications include agammaglobulinemia associated with thymoma and a label for a thymic stromal lymphopoietin blocker used in asthma, and no thymic oncology indication. This was a targeted check of these labels and pages, not an exhaustive review of FDA and EMA databases: other EMA product pages, the EMA orphan register, FDA orphan designations and FDA tissue-agnostic indications were not checked.
U 2026U 2026US Food and Drug Administration 2026US Food and Drug Administration 2026US Food and Drug Administration, openFDA drug label API (api 2026European Medicines Agency 2026EMA 2026

Trials to watch

  • RADIO-RYTHMIC NCT04731610

    After complete resection of stage II/III thymoma, does conformal postoperative radiotherapy differ from surveillance in recurrence-free survival at 3 years (the registry's primary outcome)? Registry record: randomised, open-label, parallel-group; registered as phase 'NA' although the registry title says Phase III; 314 estimated; sponsor Institut Curie. Registry status: recruiting (status verified 2026-04); no results posted.

  • Adjuvant radiotherapy for stage II/III thymoma (Fudan University) NCT02633553

    After complete resection of stage II/III thymoma, does adjuvant radiotherapy differ from observation in 5-year disease-free survival (the registry's primary outcome)? Registry record: randomised, open-label; registered as phase 'NA' although the official title says Randomized Phase III; 238 estimated; sponsor Fudan University. Registry status: recruiting (status verified 2026-04); no results posted.

  • FUSCC-Thymic 3 NCT06402708

    After complete resection of thymic carcinoma, does postoperative chemoradiotherapy differ from radiotherapy alone in 3-year disease-free survival (the registry's primary outcome)? Registry record: randomised, open-label, phase 3; 172 estimated; sponsor Fudan University. Registry status: recruiting (status verified 2026-04); no results posted.

  • 6 versus 3 cycles of neoadjuvant chemotherapy NCT07463313

    In potentially resectable locally advanced thymic epithelial tumours, does 6 cycles of neoadjuvant chemotherapy differ from 3 cycles in event-free survival at 3 years from randomisation (the registry's primary outcome)? Registry record: randomised, open-label, phase 2/3; 116 estimated; sponsor Shanghai General Hospital. Registry status: not yet recruiting (status verified 2026-03); no results posted.

  • CHOICE-2 NCT07383142

    In thymic epithelial tumours with pleural dissemination or pleural recurrence, does surgery combined with hyperthermic intrathoracic chemotherapy differ from surgery alone in 3-year progression-free survival (the registry's primary outcome)? Registry record: randomised, single-masked; registered as phase 'NA'; 202 estimated; sponsor Shanghai Zhongshan Hospital. Registry status: not yet recruiting (status verified 2026-02); no results posted.

References

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Every figure was checked against its primary source to the extent possible. Items that could not be fully confirmed are marked “needs review”. Educational history, not medical advice.

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1996UnderstandingSurgery

majorLocalisedLocally advanced

Complete resection and stage as prognostic factors in thymoma

Three surgical series looked at what predicts survival after an operation for a thymic tumour. In each, people whose tumour could be removed completely, or was at an earlier stage, tended to live longer. These are records of past patients, so they show association, not that surgery caused the difference.

Regnard (307 operated patients, 196 with myasthenia gravis): 10- and 15-year survival 67% and 57%; completeness of resection was the sole significant factor on multivariate analysis. Kondo (1,320 patients, Japan): 5-year survival in stage III-IV thymoma 93% after total resection, 64% after subtotal and 36% if inoperable. Ruffini (ESTS database): OS HR 1.74 (95% CI 1.18-2.57) for incomplete resection; stage IV versus I, 4.41 (2.67-7.26).

Why it mattered

These series are observational evidence linking complete resection and Masaoka stage to survival. In multivariate analysis Regnard found completeness of resection the only significant factor, and Kondo concluded that total resection is the most important factor. All three are observational; none is a randomised surgical comparison.

Caveats

  • Observational: an association between complete resection and survival cannot separate the effect of the operation from the extent of disease, the patient's fitness and the tumour type, and the series adjust for different factors.
  • The series differ in era, setting and design (a case series with a mean follow-up of 8 years; a compilation of records from 115 Japanese institutes for patients treated in 1990-1994; a European database covering 1990 to 2010) and include different tumour types, so their figures are not comparable with one another.
  • In the Regnard series 196 of 307 patients had myasthenia gravis; the abstract lists history of myasthenia gravis as a factor examined but does not report its result.
  • Kondo and Ruffini read adjuvant therapy differently: the Kondo authors doubted its value after total resection, whereas a propensity-score analysis of R0 resections in the ESTS database associated adjuvant therapy with better OS (HR 0.69, 95% CI 0.49-0.97). In the ESTS data the adjuvant therapy was radiotherapy in 566, chemotherapy in 44 and both in 243 of 853 patients. Both are observational and neither is specific to postoperative radiotherapy.